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Traumatic Brain Injury at Your Fingertips!

Arguably the greatest functional feature of today's most popular portable/handheld smart devices is specific application software. There is a cornucopia of “apps” to aid for any task available for download at finger length. There are more than 900 000 iPhone apps currently available, and the number of smart phone app downloads is expected to increase to 40 billion in 2014 alone.1,2 The significance of these apps lies in their functionality: they serve as interactive tools that, if designed appropriately, can play effective roles in assessing or reviewing information at a moment's notice to help one make the best possible judgment in almost any situation. Unbeknownst to most neurosurgeons and the public, neurosurgery is no exception.

As of September 10, 2013, there are more than 50 neurosurgery related apps in the iTunes store. Currently, there are more than 20 apps related to traumatic brain injury (TBI) (Table 1) for the iPhone. In addition to serving as educational resources, these apps contain a range of medical assessments including various algorithms, scales, and calculators for use by health care professionals and caretakers alike. There are also apps that attempt to provide lifestyle modifications for patients with communication ailments. Although there are several TBI-related apps in the market, a few may be considered particularly useful for neurosurgeons or as a recommendation for use by patients, and this paper is a brief review of some of these useful apps.

Traumatic Brain Injury (by Fuze.cc) (Figure A): This is an educational app developed by physicians and neurosurgeons in Brazil designed to serve as an aid to learn or review the general topics in TBI. Currently, it appears to be the most comprehensive review of TBI of all the apps on iTunes. The app contains schematic figures, pictures of real cases, scales related to TBI, in addition to the diagnosis, management, and treatment of various conditions under the umbrella of TBI. Samples of topics reviewed are TBI physiology, subdural/epidural hematoma, diffuse axonal injury (DAI), decompressive craniectomy, ventricular drain management, and various aspects of intensive care.

mTBI Pocket Guide (by The National Center for Telehealth and Technology) (Figure B) is also a very comprehensive app designed for use by providers who evaluate and treat patients with mild TBI and includes guidelines on TBI management, patient education tools, and TBI assessment and questionnaires. It can also help physicians with ICD-9 coding and provides links to various other TBI-related resources that can be very useful to those taking care of TBI patients. And the app is free! TBI Resource (by Patrick Mosa, Eastern Washington University) is an information and educational tool for families and caregivers of patients with TBI.

There are several apps that are related to concussion. Concussion (by SportSafety Labs, LLC (Figure C) is one such useful app that provides educational tools for parents, coaches, and health care providers to diagnose concussion and post concussion symptoms. It can be useful at sporting events and includes functions such as call an ambulance via 911, locate the nearest hospital with driving directions, and send your location coordinates to emergency contact and rescue personnel. SCAT2, Pocket SCAT, and SCAT 2 app: The Sport Concussion Assessment Tool 2 (SCAT2) was developed by a group of international experts at the 3rd International Consensus meeting in 2008 with the objective to standardize the method for evaluating injured athletes (>10 years age) who suffered a concussion. The app assesses concussion status by using various scales and surveys to assess pain, motor abilities, and sensation. This allows for calculation of the Standardized Assessment of Concussion (SAC) score and Maddocks questions for sideline concussion assessment. The Pocket SCAT2 is a shorter version of the SCAT2 for use by coaches and parents to assess concussion. Additionally, the “SCAT2 app” can save assessments which can be emailed to medical professionals. These apps may be more useful for other healthcare professionals, coaches, or parents to help gather data of the traumatic situation at hand as it relates to TBI. The use of these types of apps by caretakers may help to more effectively translate the information to medical services during the crucial time of injury, which may possibly result in faster response times of appropriate medical specialties and greater recovery outcomes. Return2Play for concussion (by the Pediatric Trauma program at C.S. Mott Children's Hospital and University of Michigan) (Figure D) is a concussion recovery app that helps patients track their activities and symptoms after a concussion and share this information with their health care providers.

Voice4u AAC Communication, Marti, and CanPlan: Many patients who suffer from TBI or other neurological ailments are unable to communicate effectively. These apps lend as simple tools to help facilitate not only the interaction between patients and physicians, but also between patients and others. For example, CanPlan and Marti are similar apps that allow users to make instructions for custom daily functional processes through the use of video and pictures for things such as making a cup of coffee or showing which medications to take. These videos can be made by physicians or caretakers to serves as guides for patients to be able to replicate any text required. Voice4u is a communication app that allows users to compile, select, or create phrases to show what they are talking about. This way, apps can potentially help patients by improving their ability to complete activities of daily living (ADL) and live more independently. Several associations and help groups have apps specifically designed to help people connect with them. Head injury association app (by Local media solutions) is one such app that aims to maximize TBI survivors' potential by providing support programs.

The appearance of neurosurgery related apps demonstrates a positive trend for the field. For many specialties in medicine, there have been remarkable apps that have been designed to aid physicians of all fields (ie, Epocrates). Even within neurosurgery, there exists several popular apps used by many neurosurgeons/residents/students and midlevel practitioners. NeuroMind (free, by Pieter Kubben, digitalneurosurgeon.com) is one such popular app that covers a broad list of topics including head trauma, scoring systems, and neurosurgical images. Neurosurgery survival guide ($7.99, Dr Neil Roundy) is another such app for quick reference on a broad range of neurosurgical topics. Recently, a useful reference list for apps was published in Congress Quarterly by Khan NR et al.3 However, as noted from our search, there is a paucity of true TBI-related apps. An all-encompassing app that describes management and treatment of various TBI pathologies with evidence-based neurosurgical literature would be beneficial to neurosurgical students and residents. Such an app would include a review of TBI-related topics and neuroanatomy with sources, various examples of imaging with descriptions, brief guidelines for management, description of pertinent operative procedures, and a directory of searchable drugs with information on how to use them.

We believe medical apps can play a significant role by helping to organize data. There is no doubt that patient care can be improved if new smart phone technologies are responsibly and carefully designed.

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